Abstract
Objective:Thrombocytopenia poses a significant problem in the elderly. Not only are there varied causes, but it is also associated with significant morbidity and mortality. We carried out a study to learn the causes of isolated thrombocytopenia in elderly patients and to correlate the severity of thrombocytopenia and bleeding manifestations with various etiologic factors and comorbidities. Materials and Methods:A total of 108 patients above 50 years of age presenting with isolated thrombocytopenia (platelet counts of <100x109/L with normal hemoglobin and total leukocyte counts) were enrolled in the study. Detailed history and clinical examinations were carried out for each patient. Complete blood counts were analyzed by automated cell counter. Peripheral smears were examined in all cases. HbsAg, anti-HCV, and anti-HIV testing by enzyme-linked immunosorbent assay was done in all patients. Wherever clinically indicated, bone marrow aspiration biopsy and cytogenetic studies were done. Results:Out of 108 patients, 102 (94.4%) presented with bleeding tendencies. Twenty-nine (26.8%) presented with serious (World Health Organization grade 3/4) bleedings. Major findings were immune thrombocytopenic purpura in 79 (73.1%), myelodysplastic syndrome in 7 (6.5%), drug-induced thrombocytopenia in 7 (6.5%), and connective tissue disorder in 4 (3.7%) cases. Ten patients presented with intracranial bleedings. Upon logistic regression analysis, comorbidities in the form of essential hypertension and diabetes mellitus were significantly associated with occurrence of intracranial bleeding. There was no correlation of serious bleedings with platelet counts.Conclusion:Isolated thrombocytopenia in the elderly is associated with significant morbidity. Diligent clinical and laboratory evaluation is required to elucidate the cause of thrombocytopenia in the elderly. Comorbidities in this population are associated with serious bleedings and not low platelet counts as is commonly thought.
Highlights
Thrombocytopenia poses an especially significant problem in the elderly, where it can lead to life-threatening bleedings, but may be a presenting feature of underlying hematologic malignancies, which are more common in this age group [1]
Thrombocytopenia in the elderly is associated with significant morbidity and mortality, leading to frequent hospitalizations [2]
All patients above the age of 50 years presenting with isolated thrombocytopenia to the outpatient department or admitted to the hospital with isolated thrombocytopenia were enrolled in the study
Summary
Thrombocytopenia poses an especially significant problem in the elderly, where it can lead to life-threatening bleedings, but may be a presenting feature of underlying hematologic malignancies, which are more common in this age group [1]. Thrombocytopenia in the elderly is associated with significant morbidity and mortality, leading to frequent hospitalizations [2]. The most common type of isolated thrombocytopenia, immune thrombocytopenic purpura (ITP), is not uncommon in the elderly. Compared to patients of less than 40 years of age, those older than 60 have been reported to have a higher incidence of major hemorrhagic complications of ITP and a higher ITP-related mortality [1,4]. In addition to ITP, myelodysplastic syndrome (MDS) may present as isolated thrombocytopenia in the elderly [5]
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